PURPURA AND ABNORMAL BLEEDING

PURPURA AND ABNORMAL BLEEDING: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the Following Questions:

1. Is there a petechial rash? The presence of a petechial rash suggests either a thrombocytopenic purpura, which may be idiopathic or secondary to leukemia, aplastic anemia, collagen disease, or drugs. In addition, petechiae may suggest platelet dysfunction, in which case the platelet count will be normal, or vasculitis, such as from collagen diseases, hereditary telangiectasia, scurvy, or drugs.
2. Is there ecchymosis or bruises? The presence of ecchymosis or bruises would suggest hemophilia, Christmas disease, or other major coagulation defects, but it may also be related to platelet disorders or disseminated intravascular coagulation.
3. If there is a petechial rash, is the platelet count normal? The presence of a normal platelet count would suggest either thrombocytopathy or vasculitis.
4. Is there significant mucosal bleeding? The presence of mucosal bleeding along with ecchymosis and bruises suggests platelet disorders or disseminated intravascular coagulation.

DIAGNOSTIC WORKUP

If a coagulation disorder is suspected, consult a hematologist first. Routine diagnostic studies include a CBC, platelet count, sedimentation rate, blood smear for red cell morphology, urinalysis, chemistry panel, coagulation profile, rheumatoid arthritis factor, ANA test, serum protein electrophoresis, VDRL test, EKG, chest x-ray, and flat plate of the abdomen. The coagulation profile should include a platelet count, a bleeding time, a coagulation time, a partial thromboplastin time, and a prothrombin time.

If there is fever, blood cultures should be done. A bone marrow examination and bone marrow culture may be useful. If disseminated intravascular coagulation is suspected, a fibrinogen assay and estimation of fibrin degradation products should be done. Platelet function may be assessed by clot retraction tests. Spleen and liver scans and bone scans may be needed. A CT scan of the abdomen and pelvis may also be necessary. Skin, muscle, and even kidney biopsies are often done to complete the workup.

It can be seen from the above array of diagnostic tests that a hematologist should be consulted at the outset. Various forms of vasculitis may be confirmed by skin or muscle biopsy.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

More About Goodpasture syndrome

• Back to disease: Goodpasture syndrome: Introduction
• Next Book Extract About Goodpasture syndrome: Hematuria (In a Page: Signs and Symptoms)
• More Book Extracts: All Online Books for Goodpasture syndrome

More Medical Textbooks Online about Goodpasture syndrome

Review other book chapters online related to Goodpasture syndrome:

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

 » Next page: Hematuria (In a Page: Signs and Symptoms)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Hematuria (In a Page: Signs and Symptoms)
• Purpura (In a Page: Signs and Symptoms)
• Hematuria (In A Page: Pediatric Signs and Symptoms)
• Purpura (In A Page: Pediatric Signs and Symptoms)
• HEMATURIA (Differential Diagnosis in Primary Care)

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City